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MSF 4274 REV 02/18 APPLICATION FOR AN ORAL EXAMINATION LEADING TO THE ISSUE OF A CERTIFICATE OF COMPETENCY (STCW) FOR Masters, Chief Mates and Deck Officers in the Merchant NavyMDIMPORTANT BEFORE

How to fill out msf 4274 rev 0218

How to fill out msf 4274 rev 0218

1. To fill out MSF 4274 Rev 0218, follow these steps:
2. Start by entering the name, address, and contact information of the individual or organization submitting the form.
3. Provide the name and contact information of the person who can provide additional information or answer questions about the form.
4. Indicate whether the submission is for a new enrollment, an enrollment change, or a disenrollment.
5. Fill in the beneficiary details such as name, date of birth, and relationship to the subscriber.
6. Provide any specific information related to coverage, including the type of plan, effective date, and desired premium amount.
7. If applicable, include information about other health insurance coverage and whether this coverage will be maintained or terminated.
8. Include any additional comments or explanations that may be necessary to support the enrollment or disenrollment request.
9. Review the completed form for accuracy and completeness before submitting it.
10. Sign and date the form to certify the information is true and accurate.
11. Submit the filled-out form to the appropriate recipient as instructed.

Who needs msf 4274 rev 0218?

1. MSF 4274 Rev 0218 is needed by individuals or organizations who are enrolling, making enrollment changes, or disenrolling in a health insurance plan.
2. It is typically used by subscribers or beneficiaries to provide necessary information for enrollment purposes.
3. This form is commonly utilized in the healthcare industry by insurance carriers, employers, or individuals who manage health insurance plans.

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